COMMUNITY ORGANIZATIONS AND HIV PREVENTION IN TANZANIA

By Rebecca BenestStaff Writer

AIDS is no one thing. AIDS is there when your husband drinks and comes home late at night and beats you… when he loses his job and turns to other women...when the rains don’t come and the borehole dries up… when you are working very hard selling vegetables until the police come and push you out and take away your vegetables and you have no money to buy more. AIDS is when your children are hungry and there is no food… when your baby is sick and the clinic says nothing can be done. Your husband pushes you out of the house and you have not even clothes enough to cover you, so what can you do? He doesn’t want to talk about AIDS. Now he is dead. His family comes to take away all the things in the house, so you have nothing. No one is there to help you. It is a long story. That is the story of AIDS.- Chipo, 39-year-old Zimbabwean AIDS victim

The seemingly unending pandemic of HIV/AIDS in Africa holds an incredible allure for both foreign aid NGOs and the global community as a whole. Billions of dollars are invested into various AIDS prevention programs, while thousands of volunteers are sent into different countries throughout the African continent to help these programs distribute medication and educate Africans in safe sex methods in order to help stop the spread of the virus. Despite all this, however, the rates of HIV/AIDS are not diminishing as expected. Many programs, especially those implemented in southern Africa where AIDS levels are highest, saw a rise in infection after foreign programs were implemented. There was a significant drop, however, in southern Uganda and northern Tanzania during the 1980s and 1990s while HIV rates in the rest of Africa were still rising (Epstein 161). This is because of the specific African-run organizations, which began in this area and have led to the drops in HIV/AIDS levels. The solution to reducing HIV is found in the organizations run by African women, who stand up to help each other with the crucial understanding of which cultural institutions have created the pandemic. Furthermore, the networks within their communities are what allows them to truly create a difference in societal structures.Currently, 1.6 million Tanzanians, or 6 percent of the population, are living with AIDS, though levels have been declining in recent years (Evans 1). The probability of getting infected, however, is incredibly skewed towards women. HIV is five times as prevalent among teenage girls than among teenage boys, which is the result of several gendered vulnerabilities (Reeuwijk 5). As some might assume, this is not due to higher rates of prostitution or promiscuity in African communities. In fact, the average African has had significantly less sexual partners through the course of their lives than the average American (Epstein 56).In 2008, a study crucial to understanding female vulnerabilities to contracting HIV was published using information from Moshi, Tanzania, and using a population of 1,500 women aged 20 to 44. It tested the multiple dimensions of gender power asymmetries that can potentially increase women’s risk for HIV infection. They found that women were 2.5 times more likely to contract HIV if they had a partner more than 10 years older, that they were 1.7 times more likely to contract HIV if their partner didn’t make significant financial contributions to their children’s welfare, and that they were two times more likely to contract HIV if they experienced forced sex before age 18 (Sa, Larsen 1). These findings point to specific cultural practices that can increase women’s risk for HIV/AIDS.Children, especially young girls, also see an increased risk for HIV/AIDS, both through mother-to-child transmission and through childhood promiscuity. Without medical intervention, 30 to 45 percent of children born to HIV-positive mothers will contract the virus either during pregnancy, delivery, or breastfeeding (Leshabari et. al. 545). Additionally, with an average household of 4 to 5 children, many work outside the home to earn extra money, with boys using the money to seduce girls, giving girls the potential to use this to earn extra money (Harms et. al. 260). More so for girls than for boys, children are at a legitimate risk to become infected or to experienced unwanted sex or even pregnancies (Reeuwijk 217). This risk is additionally increased as poverty enforces many of these structures.During the 1980s and 1990s, when observers witnessed a significant drop in HIV/AIDS among the population, it was traced back to hundreds of small community-based HIV prevention organizations within Tanzanian and Ugandan towns and villages. These organizations, comprised of the members of those communities dedicated to this cause, served to help care for the sick and orphans and to address the particular vulnerabilities of women and girls to the virus resulting from the cultural structures they saw as particularly damaging. Their passion and work to create a change was what ultimately “brought the disease into the open, got people talking about the epidemic, reduced AIDS-related stigma and denial, and led to a profound shift in sexual norms” (Epstein 160). These organizations were able to create the change that foreign aid organizations, even with billions of dollars, were unable to accomplish. The people in these communities understood much more quickly than their governments and foreign NGOs that the disease won’t always be traceable to prostitutes and other marked high-risk groups (Flynn et. al. 34). This understanding allowed them to directly address the cultural institutions they felt, from experience, were responsible for the epidemic.There are several organizations like this that have now gained influence and spread throughout several countries in Africa. Intervention with Microfinance for AIDS and Gender Equity (IMAGE) is an on-the-ground organization to promote women’s rights, with the fitting slogan of ‘women supporting women.’ After implementing the program, participating women saw their risk of domestic violence halved compared to those not participating, and reported that their partners had started to treat them with more respect in their value and contributions (Epstein 249). By bringing women together to help each other solve problems that could not be solved individually, these women found the voice to speak out to their larger community about both HIV and women’s rights as a whole. When a girl in one village was raped and the police didn’t take any action to help her or her family, IMAGE started a rape committee and demanded action from the police; they also demanded better HIV/AIDS services from hospitals, putting them on headlines in local newspapers (Epstein 250). Their commitment and voice gave them the influence in their communities needed to encourage people to both listen and change.These women’s experience and participation in the cultures in which they’re working gives them the ability to judge correctly which institutions are encouraging the spread of HIV and which are not relevant. For this reason, none of these African women-based organizations are promoting education of schoolchildren in safe sex practicing; they’re encouraging a core change in the communities’ gender and economic asymmetries to prevent situations that condone unsafe sex as a means of survival. Furthermore, the networks these women have within their communities give them the influence to create a change in the way the people see themselves. The women speaking out about women’s rights at church meetings and school conferences are known by the community; because of this, when they talk about the respect and sexual equality women deserve, other community members are more likely to listen and understand.The city of Bukoba, Tanzania, is a good example to epitomize what was seen in the rest of the Tanzanian and Ugandan areas where HIV rates were seen to drop so noticeably. It is the capital of the Kagera Region, the region in northern Tanzania where the HIV epidemic was first discovered and where it first exploded and started to spread. By 1987, around the height of the HIV epidemic in the area, around a quarter of all adults in Bukoba were HIV positive. After what we now know was the impact of the African-based community organizations, however, these high levels dropped drastically; HIV levels were halved by 1996 down 80 percent by 2003 (Epstein 158). In comparison, although Francistown, Botswana, had similar rates of infection to those in Tanzania and Uganda in the 1980s, while rates were halved in Bukoba they doubled in Francistown (Epstein 159).The success of these groups in comparison to those established by foreign NGOs and government organizations, however, doesn’t mean that there isn’t a place for foreign aid in the prevention of AIDS or the building of other infrastructure in Africa or in other countries of the third world. It does mean, however, that foreign organizations without a core understanding of the culture in the communities they’re working in and strong ties to groups from within that community will not be successful as those who do. It means that foreign aid will be most helpful and efficient when dedicated to helping those organizations founded from within the community and dedicated to making the structural changes they know, from experience, will create the results they aim to see.Photo by Medici con l'Africa Cuamm---Work CitedEpstein, Helen. 2007. The Invisible Cure: Africa, the West, and the Fight Against AIDS. New York: Farrar, Straus and Giroux.Evans, Ruth M. C. 2005. "Social Networks, Migration, and Care in Tanzania: Caregivers' and Children's Resilience to Coping with HIV/AIDS." Journal of Children & Poverty11(2):111-129(http://search.proquest.com/docview/60028103?accountid=14524).Flynn, Karen, Ezekiel Kalipeni and Cynthia Pope. 2009. Strong Women, Dangerous Times: Gender and HIV/AIDS in Africa. New York, NY: Nova Science Publishers, Inc.Harms, Gundel, Katja Schulze, Ilaria Moneta, Chris Baryomunsi, Paulina Mbezi and Gabriele Poggensee. 2005. "Mother-to-Child Transmission of HIV and its Prevention: Awareness and Knowledge in Uganda and Tanzania." Sahara J: Journal of Social Aspects of HIV/AIDS/Journal De Aspects Sociaux Du VIH/SIDA 2(2):258-266 (http://search.proquest.com/docview/59992386?accountid=14524).Leshabari, S. C., A. Blystad and K. M. Moland. 2007. "Difficult Choices: Infant Feeding Experiences of HIV-Positive Mothers in Northern Tanzania." Sahara J: Journal of Social Aspects of HIV/AIDS/Journal De Aspects Sociaux Du VIH/SIDA 4(1):544(http://search.proquest.com/docview/61676257?accountid=14524).Reeuwijk, Miranda van. 2010. Because of Temptations: Children, Sex and HIV/AIDS in Tanzania. Diemen, the Netherlands: AMB Publishers.Sa, Zhihong and Ulla Larsen. 2008. "Gender Inequality Increases Women’s Risk of HIV Infection in Moshi, Tanzania." Journal of Biosocial Science40(4):505-525 (http://search.proquest.com/docview/810410654?accountid=14524).